Recent Submissions

  • A systematic review of the cost-effectiveness of community and population interventions to reduce the modifiable risk factors for dementia

    Brain, Jacob; Stephan, Blossom C. M. (2022)
    Population-based health and lifestyle interventions, which change societal conditions such that everyone across a given community is more likely to live more healthily, have been under-researched within the context of dementia prevention and risk reduction. This systematic review finds such interventions highly cost-effective, and often also cost-saving, in both high- as well as low- and middle-income settings. The strongest evidence base was for interventions that changed the physical environment to decrease physical inactivity or obesity, financial interventions that improved access to or resources for education, and mass media programmes that changed the social environment around smoking.
  • Recovery Colleges Characterisation and Testing in England (RECOLLECT): rationale and protocol

    Repper, Julie; Brewin, John; Sara, Meddings; McPhilbin, Merly; Yeo, Caroline; Slade, Mike (2022)
    Recovery Colleges are a relatively recent initiative within mental health services. The first opened in 2009 in London and since then numbers have grown. They are based on principles of personal recovery in mental health, co-production between people with lived experience of mental health problems and professionals, and adult learning. Student eligibility criteria vary, but all serve people who use mental health services, with empirical evidence of benefit. Previously we developed a Recovery College fidelity measure and a preliminary change model identifying the mechanisms of action and outcomes for this group, which we refer to as service user students. The Recovery Colleges Characterisation and Testing (RECOLLECT) study is a five-year (2020–2025) programme of research in England. The aim of RECOLLECT is to determine Recovery Colleges’ effectiveness and cost-effectiveness, and identify organisational influences on fidelity and improvements in mental health outcomes. 
  • Practitioners’ views on enabling people with dementia to remain in their homes during and after crisis

    Coleston-Shields, Donna M.; Stanyon, Miriam R.; Yates, Jennifer A.; Streater, Amy; Orrell, Martin (2022)
    One way of supporting people living with dementia is assisting them to live in their homes (as opposed to being admitted to hospital or other facility) and providing them with a specialist service that responds to crises. This makes it important to understand how best to organize such crisis response services. This study examines practitioners’ actions to reduce inpatient admissions among this population. Through interviews with healthcare practitioners, we find that practitioners negotiate a complex intersection between (1) what constitutes a crisis in relation to the patient and/or the carer, (2) the demands of building a working relationship with both the patient and their family carers, and (3) ensuring effective communications with social services responsible for long-term community support. Findings suggest that policies aimed at reducing admissions should be based on a model of care that more closely maps practitioners’ relational and bio-medical work in these services.
  • Therapist-supported internet-delivered exposure and response prevention for children and adolescents with Tourette syndrome: A randomized clinical trial

    Hall, Charlotte L.; Davies, E. Bethan; Hollis, Chris P. (2022)
    The availability of behavior therapy for individuals with Tourette syndrome (TS) and chronic tic disorder (CTD) is limited.To determine the efficacy and cost-effectiveness of internet-delivered exposure and response prevention (ERP) for children and adolescents with TS or CTD.This single-masked, parallel group, superiority randomized clinical trial with nationwide recruitment was conducted at a research clinic in Stockholm, Sweden. Out of 615 individuals assessed for eligibility, 221 participants meeting diagnostic criteria for TS or CTD and aged 9 to 17 years were included in the study. Enrollment began in April 2019 and ended in April 2021. Data were analyzed between October 2021 and March 2022.Participants were randomized to 10 weeks of therapist-supported internet-delivered ERP for tics (111 participants) or to therapist-supported internet-delivered education for tics (comparator group, 110 participants).The primary outcome was change in tic severity from baseline to the 3-month follow-up as measured by the Total Tic Severity Score of the Yale Global Tic Severity Scale (YGTSS-TTSS). YGTSS-TTSS assessors were masked to treatment allocation. Treatment response was operationalized as a score of 1 (“Very much improved”) or 2 (“Much improved”) on the Clinical Global Impression–Improvement scale.Data loss was minimal, with 216 of 221 participants (97.7%) providing primary outcome data. Among randomized participants (152 [68.8%] boys; mean [SD] age, 12.1 [2.3] years), tic severity improved significantly, with a mean reduction of 6.08 points on the YGTSS-TTSS in the ERP group (mean [SD] at baseline, 22.25 [5.60]; at 3-month follow-up, 16.17 [6.82]) and 5.29 in the comparator (mean [SD] at baseline, 23.01 [5.92]; at 3-month follow-up, 17.72 [7.11]). Intention-to-treat analyses showed that the 2 groups improved similarly over time (interaction effect, −0.53; 95% CI, −1.28 to 0.22; P = .17). Significantly more participants were classified as treatment responders in the ERP group (51 of 108 [47.2%]) than in the comparator group (31 of 108 [28.7%]) at the 3-month follow-up (odds ratio, 2.22; 95% CI, 1.27 to 3.90). ERP resulted in more treatment responders at little additional cost compared with structured education. The incremental cost per quality-adjusted life-year gained was below the Swedish willingness-to-pay threshold, at which ERP had a 66% to 76% probability of being cost-effective.Both interventions were associated with clinically meaningful improvements in tic severity, but ERP led to higher response rates at little additional cost.ClinicalTrials.gov identifier: NCT03916055
  • Mental health workers’ perspectives on peer support in high-, middle- and low income settings: a focus group study

    Charles, Ashleigh (2022)
    Peer support is increasingly acknowledged as an integral part of mental health services around the world. However, most research on peer support comes from high-income countries, with little attention to similarities and differences between different settings and how these affect implementation. Mental health workers have an important role to play in integrating formal peer support into statutory services, and their attitudes toward peer support can represent either a barrier to or facilitator of successful implementation. Thus, this study investigates mental health workers’ attitudes toward peer support across a range of high- (Germany, Israel), middle- (India), and low-income country (Tanzania, Uganda) settings.
  • Feasibility and acceptability of experience sampling among LGBTQ+ young people with self-harmful thoughts and behaviours

    Arcelus, Jon (2022)
    This study was the first to determine whether it was feasible and acceptable to use experience sampling methods (ESM) among LGBTQ+ young people, who had current experiences of self-harm. Sixteen LGBTQ+ young people (16–25 years old) took part in the experience sampling study. This included a baseline assessment, a 7-day ESM assessment (participants were sampled six times a day using a phone app), and the option of an interview at the end of the 7-day ESM assessment. Feasibility data was descriptively analysed, with pilot ESM data presented. Qualitative data was thematically analysed to determine the acceptability (barriers and facilitators) of taking part in this study. Study feasibility was assessed by enrolment rate (55.2%), participant retention across assessment period (100%), ESM app feasibility (87.5%), and good adherence to total number of ESM surveys (67.6%). Individual study adherence ranged between 43 and 95.2%. Study acceptability was assessed by participant interviews. Thematic analysis indicated four superordinate themes; (i) Self-reflection and awareness; (ii) Practicalities of ESM surveys; (iii) Daily timeframes; and (iv) Suggestions for future studies. Pilot ESM data demonstrates that there was fluctuation of depressive and anxiety symptoms within- and between- participants over the course of the study, however, greater sample power is needed for full analysis. This study demonstrated that ESM designs are feasible and acceptable among LGBTQ+ young people with current experiences of self-harm. Pilot data indicated that specific experiences and moods are likely to be important to self-harm. These potentially have a temporal influence on self-harm behaviour or ideation, and therefore should be examined in a fully powered sample.
  • "I'm in pain and I want help": An online survey investigating the experiences of tic-related pain and use of pain management techniques in people with tics and tic disorders

    Davies, E. Bethan (2022)
    OBJECTIVES: Tic disorders (TDs) are complex neurological conditions characterized by involuntary, persistent vocalizations and motor movements called tics. Tics involve brief muscle movements and can impair many aspects of daily functioning and quality of life in patients - and their physical nature can cause pain. Understanding individuals' experiences of tic-related pain and pain management could help explore this under-researched area and identify additional support needs for this population. The aim of this study was to investigate experiences of pain and use of pain management techniques in people with tic disorders. METHODS: An online survey consisting of multiple choice and open-ended questions exploring experiences of tic-related pain, help-seeking behavior for tic-related pain, and use of pain relief techniques for tic-related pain, was circulated online via international Tourette syndrome patient associations, and one online support group for Tourette syndrome. The online survey was open to adults (≥16 years) with self-reported tics. Open-ended questions were analyzed using thematic analysis. RESULTS: One hundred eighty-one participants (16-71 years; 58.0% female) from 18 countries completed the online survey. Several aspects of tics were associated with pain, including the physical effort of motor tics (n = 177, 97.8%), repetitive tics (n = 141, 77.9%) and the consequences of tics (n = 131, 72.4%). Nearly two-thirds (n = 118, 64.6%) had sought professional help for tic-related pain. Distraction techniques (n = 126, 69.6%), taking pain relief medication (n = 125, 69.1%) and altering tics (n = 111, 61.3%) were the most commonly-reported methods used to relieve and cope with tic-related pain. Thematic analysis found an interrelated complex relationship between participants' tics, pain, and pain management techniques, reflected in four themes: the "tic-pain" cycle, the impact of pain, the importance of support, and the perceived successfulness of pain management techniques. CONCLUSIONS: Tic-related pain was reported to have a significant physical and psychological impact which impacted aspects of daily living in people with tic disorders. The findings add to limited research suggesting tic-related pain is a dominant issue for individuals with tic disorders, potentially impacting upon their quality of life. Increased understanding of tic-related pain and its influence may be helpful in the long-term management of tic disorders, both in terms of clinical management and patients' self-management.
  • ‘Maybe I shouldn’t talk’: The role of power in the telling of mental health recovery stories

    Llewellyn-Beardsley, Joy; Rennick-Egglestone, Stefan; Ali, Yasmin; Watson, Emma; Yeo, Caroline; Ng, Fiona; Slade, Mike (2022)
    Mental health ?recovery narratives? are increasingly used within teaching, learning and practice environments. The mainstreaming of their use has been critiqued by scholars and activists as a co-option of lived experience for organisational purposes. But how people report their experiences of telling their stories has not been investigated at scale. We present accounts from 71 people with lived experience of multiple inequalities of telling their stories in formal and informal settings. A reflexive thematic analysis was conducted within a critical constructivist approach. Our overarching finding was that questions of power were central to all accounts. Four themes were identified: (1) Challenging the status quo; (2) Risky consequences; (3) Producing ?acceptable? stories; (4) Untellable stories. We discuss how the concept of narrative power foregrounds inequalities in settings within which recovery stories are invited and co-constructed, and conclude that power imbalances complicate the seemingly benign act of telling stories of lived experience.
  • Self-help digital interventions targeted at improving psychological well-being in young people with perceived or clinically diagnosed reduced well-being: Systematic review

    Babbage, Camilla M.; Jackson, Georgina M.; Davies, E. Bethan; Nixon, Elena (2022)
    Background: Levels of well-being are declining, whereas rates of mental health problems remain high in young people. The World Health Organization defines mental health as not merely the absence of mental disorder but also includes social and psychological well-being as integral to positive mental health, highlighting that mental health is applicable to young people with mental health conditions and those without a diagnosis of a mental health condition. Reduced mental well-being have been identified in studies of young people with clinical populations, as well as in populations consisting of nonclinical young people. Self-help digital interventions can be delivered at mass at a low cost and without the need for trained input, thereby facilitating access to support for well-being. Self-help interventions are effective in young people with mental health conditions, but systematic reviews of such studies have been limited to randomized controlled trials, have not included reduced well-being as an inclusion criterion, and do not consider engagement factors such as retention. Objective: The objective of this study was to systematically review all controlled studies of digitally delivered, self-administered interventions for young people aged 9 to 25 years, with perceived or clinically diagnosed reduced psychological well-being. Participant retention and effectiveness of the interventions were also explored. Methods: A systematic search of the PsycInfo, EMBASE, Cochrane, Scopus, and MEDLINE databases from inception to 2021, reference searches of relevant papers, and gray literature was carried out for digitally controlled studies conducted with young people with perceived or clinically diagnosed reduced well-being, aimed at improving psychological well-being. Data were extracted to identify the effectiveness and retention rates of the interventions and the quality of the studies. Results: Overall, 1.04% (12/1153) of studies met the inclusion criteria: 83% (10/12) of studies were randomized controlled trials and 17% (2/12) were controlled pre-post studies. Most (6/12, 50%) studies aimed to improve symptoms of depression; 3 interventions aimed at both anxiety and depressive symptoms and 2 studies aimed at improving social functioning difficulties. Owing to the high risk of bias across interventions and lack of similar outcome measures, a meta-analysis was not conducted. Retention rates across studies were regarded as good, with moderate to high retention. Overall, the findings indicated that predominantly self-administered self-help interventions improved well-being in the areas targeted by the intervention and identified additional areas of well-being that were positively affected by interventions. Few interventions supported psychological well-being that was different from those used by young people with a clinical diagnosis of mental illness or young people from neurodiverse backgrounds. Conclusions: The findings, along with the advantages of self-help interventions, highlight the need for upscaling self-help interventions to better support vulnerable populations of young people who experience poor psychological well-being. Trial Registration: PROSPERO CRD42019129321; https://tinyurl.com/4fb2t4fz
  • Dietary nitrate and brain health. Too much ado about nothing or a solution for dementia prevention?

    Stephan, Blossom C. M. (2022)
    Dementia is a significant public health priority with approximately 55 million cases worldwide, and this number is predicted to quadruple by 2050. Adherence to a healthy diet and achieving optimal nutritional status are vital strategies to improve brain health. The importance of this area of research has been consolidated into the new term ‘nutritional psychiatry’. Dietary nitrate, closely associated with the intake of fruits and vegetables, is a compound that is increased in dietary patterns such as the Mediterranean and MIND diets and has protective effects on cognition and brain health. Nitrate is characterised by a complex metabolism and is the precursor of the nitrate–nitrite–nitric oxide (NO) pathway contributing to systemic NO generation. A higher intake of dietary nitrate has been linked to protective effects on vascular outcomes including blood pressure and endothelial function. However, the current evidence supporting the protective effects of dietary nitrate on brain health is less convincing. This article aims to provide a critical appraisal of the current evidence for dietary nitrate supplementation for improving brain health and provide suggestions for future research.
  • Dementia Early-Stage Cognitive Aids New Trial (DESCANT) of memory aids and guidance for people with dementia: randomised controlled trial

    Orrell, Martin; Challis, David; Chester, Helen; Hughes, Jane (2022)
    Background Common memory aids for people with dementia at home are recommended. However, rigorous evaluation is lacking, particularly what guidance or support is valued.Objective To investigate effects of memory aids and guidance by dementia support practitioners (DSPs) for people in early-stage dementia through a pragmatic, randomised controlled trial.Methods Of 469 people with mild-to-moderate dementia and their informal carers, 468 were randomised to a DSP with memory aids or to usual care plus existing dementia guide. Allocation was stratified by Trust/Health Board; time since first attendance at memory service; gender; age; and living with primary carer or not. Primary outcome was Bristol Activities of Daily Living Scale (BADLS) Score at 3 and 6 months (primary end-point). Secondary outcomes for people with dementia: quality of life (CASP-19; DEMQOL); cognition and functioning (Clinical Dementia Rating Scale; S-MMSE); capability (ICECAP-O); social networks (LSNS-R); and instrumental daily living activities (R-IDDD). Secondary outcomes for carers: psychological health (GHQ-12); sense of competence (SSCQ).Results DSPs were successfully trained, compliance was good and welcomed by participants. Mean 6 months BADLS Score increased to 14.6 (SD: 10.4) in intervention and 12.6 (SD: 8.1) in comparator, indicative of greater dependence in the activities of daily living. Adjusted between-group difference was 0.38 (95% CI: −0.89 to 1.65, p=0.56). Though this suggests greater dependency in the intervention group the difference was not significant. No differences were found in secondary outcomes.Conclusions This intervention did not maintain independence in the activities of daily living with no improvement in other outcomes for people with dementia or carers.Trial registration number Current Controlled Trials ISRCTN12591717.Data are available upon reasonable request. Data are available on reasonable request from the corresponding author
  • Acute effects of physical activity on cognitive function in children and adolescents with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis

    Groom, Madeleine J. (2022)
    Attention-deficit/hyperactivity disorder (ADHD), one of the most common neurodevelopmental disorders in children and adolescents, is typically managed with medications which are associated with negative side effects. Therefore, non-pharmacological treatments, such as physical activity, are an attractive option. The aim of this meta-analysis was to explore the effects of acute physical activity on cognition in children and adolescents with ADHD. A comprehensive search of three literature databases yielded 14 studies for inclusion. An overall meta-analysis was conducted alongside sub-group analyses for cognitive domain, physical activity characteristics, and timing of cognitive measurements. Results revealed a small beneficial effect of physical activity on cognitive function (SMD = 0.18, [0.12,0.25], p < 0.01). Sub-group analyses revealed beneficial effects of physical activity on the domains of cognitive flexibility (SMD = 0.21, [0.09,0.32], p < 0.01), attention (SMD = 0.20, [0.09,0.32], p = 0.001), and inhibitory control (SMD = 0.18, [0.03,0.33], p = 0.02), but not memory (p = 0.87). Cognitive benefits also differed depending on physical activity duration (<10 min, p = 0.27; 11–20 min, SMD = 0.23, [0.14,0.31], p < 0.01; >20 min, SMD = 0.13, [-0.00,0.26], p = 0.05), and modality (running, SMD = 0.21, [0.12,0.29], p < 0.01; ‘other’, SMD = 0.39, [0.18,0.61], p < 0.01; cycling, p = 0.35), and the timing of cognitive measurement following physical activity (immediately, SMD = 0.17, [-0.01,0.35], p = 0.06; 2–10 min, SMD = 0.21, [0.12,0.30], p < 0.01; >10 min, SMD = 0.19, [-0.09,0.47], p = 0.19). Overall, physical activity has a positive acute effect on subsequent cognition in children and adolescents with ADHD, though effects may be domain specific and influenced by the duration and modality of physical activity. These findings have practical implications for those interested in using physical activity to enhance cognition in children and adolescents with ADHD.
  • Taking a position within powerful systems

    Coles, Steven (2022)
    Psychiatric diagnosis remains the dominant model for conceptualising mental health difficulties and psychological distress. Psychiatric discourses rooted in the biomedical and biopsychosocial models are structurally embedded within service design throughout the UK and determine service provision, access to help and support, research grants, and overwhelmingly shape policy and legislation. Within this socio-political context, clinical and community psychologists continue to develop alternative conceptual frameworks and practices to counter individualising and arguably pathologising constructs of disorder and mental illness. As practitioners become increasingly outwardly looking and focus efforts on changing the underlying socio-materialist conditions that shape psychological distress, the need to recalibrate clinical psychology to address inequality, discrimination and social injustice as a matter of course is irrevocable. For many psychologists working in organisations designed on the basis of diagnostic discourses, the question as to how one positions themselves in-line with pre-existing psychiatric practices is crucial. Does one integrate approaches or question and challenge these psychiatric practices more overtly? Alternatively, could clinical and community psychology achieve a more ethical and conceptually coherent practice through activism to protest against the dominance of psychiatric diagnosis? This chapter explores how clinical psychologists position themselves in contexts where psychiatric diagnosis is the prevailing mode of practice, and it then goes on to explore what lessons clinical psychology can learn from community psychology when it comes to questions of psychological distress and psychiatric disorder. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Source: book)
  • Adapting the protocol for narrative exposure therapy for adults with mild intellectual disabilities

    Marlow, Katie; Schroder, Thomas; Renton, Jess (2022)
    Background Narrative exposure therapy (NET) is a trauma‐focused cognitive behavioural therapy, recommended by the National Institute for Health and Care Excellence in 2018, to treat posttraumatic stress disorder in adults. There is a lack of research exploring the effectiveness of NET with adults with intellectual disabilities. The aim of this study is to develop an adapted version of the NET protocol (IDNET) for use with adults with mild intellectual disability. Methods A qualitative research design was employed. Stage one involved systematically adapting the NET protocol for adults with mild intellectual disabilities in collaboration with a service user group comprising eight consultants. Stage two involved gaining professionals' views on the adapted protocol and on the use of NET in intellectual disability services. This comprised a focus group of eight clinical psychologists specialising in intellectual disabilities and an expert panel of three NET clinicians. The framework approach was conducted on the focus group data only following guidance from a previous study. Findings An adapted NET protocol and collection of ‘easy read’ therapy materials were developed (IDNET), which incorporated feedback from the three stakeholder groups. Key concepts of ‘Optimism and motivation to adapt NET for people with mild intellectual disabilities’ and ‘Factors related to NET in practice’ were developed to describe the views of clinical psychologists. A number of issues were raised by professionals regarding the delivery of IDNET. Conclusions Professionals were optimistic about IDNET; however, issues raised regarding the delivery of IDNET require exploration when IDNET is trialled in practice. Specific implications for clinical practice and future research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Source: journal abstract)
  • Digital and remote behavioral therapies for treating tic disorders: Recent advances and next steps

    Khan, Kareem; Hollis, Chris P.; Hall, Charlotte L. (2022)
    The rapid expansion of access to and engagement with digital technology over the past 15 years has transformed the potential for remote delivery of evidence-based digital health interventions (DHIs). Digital and remote behavioral interventions have the potential to address current gaps in the provision of evidence-based therapies in healthcare services. As the lack of access to behavioral treatments for people with tic disorders is a pressing issue across the world, there is great potential for DHIs to close this treatment gap. Here, we present a critical synthesis of the recent key advances in the field of digitally delivered, remote therapy for tics, outlining the research evidence for the clinical and cost-effectiveness and acceptability of digital or remotely delivered therapy. We found five trials aimed at reducing tic severity in children and young people and one trial for adults. The evidence supports the clinical utility of DHIs to deliver tic therapies, which shows promise in being clinically efficacious compared to an active control. Furthermore, DHIs in trials show good adherence and engagement and are acceptable to patients. The role of human support (including therapists and parents for young people) is likely to be important to encourage adherence. DHIs, where the main therapeutic content is delivered via web-based chapters, are likely to reduce clinical time, and maintain intervention fidelity, but further research is required to understand cost-effectiveness. Despite utilizing randomized controlled trials, only two trials were sufficiently powered to address efficacy and only one trial explored contextual factors that may influence engagement. Moreover, only one trial followed patients for >12 months, thus further long-term follow-ups are required. Specifically, we note that despite an emerging evidence base, DHIs for tics are yet to be routinely implemented in healthcare provision in any country. Drawing on the existing evidence, we conclude by proposing a stepped care model, in which digital therapy is implemented as a widely accessible first-line treatment using a purely online or therapist-supported approach.
  • A call for caution: 'stop that' sentiments threaten tic research, healthcare and advocacy

    Davies, E. Bethan (2022)
    Recent reports from Tourette syndrome clinical researchers in North America and Europe1,2 describe a recent increase in young patients presenting to Tourette syndrome clinics. Reported commonalities in clinical presentation include a female preponderance, older age of first detected symptoms, complex behaviours (e.g. phrases, coprolalia, long/sequenced movements), significant functional impairment, and similarities to behaviours recorded in videos on social media platforms, notably TikTok. This has raised important questions about aetiology and how to best diagnose and treat these individuals. In their recent Brain paper, Müller-Vahl et al.3 postulated that this phenomenon is a ‘mass sociogenic illness.’ The function of this assertion could be to caution clinicians and patients against using interventions contraindicated for those with functional movement disorder (FMD). However, this postulate does not follow neatly from the current state of the evidence, and the rhetorical language used risks negatively impacting patients by implying that these symptoms are ‘attention seeking’ behaviours. In this response, written by a group of Tourette syndrome researchers, clinicians, and individuals with tics, we detail concerns with the paper.
  • Investigating the relationship between bullying involvement and self-harmful thoughts and behaviour in young people: A systematic review

    Sayal, Kapil (2022)
    BACKGROUND: There is a complex and inconsistent relationship between bullying involvement and self-harmful thoughts and behaviour (SHTB) in young people. This novel systematic review aims to establish key interacting, moderating and mediating variables associated with SHTB in young people involved in bullying. METHODS: The systematic review was registered with PROSPERO: CRD42020192023. A search was conducted (until February 2021) across databases: PubMed/MEDLINE, EMBASE, PsycINFO (Ovid), Cochrane Library, Scopus (Elsevier), Web of Science, ERIC and CINAHL (EBSCOhost). Observational studies containing quantitative primary or secondary data analyses were included in the review, on the basis that they examined interactions, moderators, or mediators between bullying involvement and SHTB in young people. Versions of the Newcastle-Ottawa Scale were used to assess risk of bias in the included studies. RESULTS: A total of 57 studies were included. Overall, 3 studies identified interactions, 25 studies identified moderators and 21 studies identified mediators. 9 studies identified moderator-mediators. The findings were categorised as either self-harmful thoughts or self-harmful behaviours and synthesised under the following themes: socio-demographic; depression; parental; personality/psychological; and social/environmental. LIMITATIONS: This review uncovered significant heterogeneity and a paucity of replicated studies in the field, therefore, tentative conclusions have been drawn. CONCLUSIONS: This comprehensive review highlights the key role of depression as a mediator between traditional/cyber victimisation and SHTB in young people. The moderating effects of gender on mediation models investigating the role of depression suggest the possibility that females involved in bullying may be at increased suicide risk.
  • Trajectories of adolescent psychotic-like experiences and early cannabis exposure: Results from a Finnish Birth Cohort Study

    Sami, Musa (2022)
    BACKGROUNDLongitudinal studies examining the effect of cannabis exposure (CE) on the prognosis of adolescents with psychotic-like experiences (PLEs) are scarce. We examined trajectories of mental health in adolescents with PLEs and cannabis exposure.METHODSThe Northern Finland Birth Cohort 1986 (n = 6552) with linkage to nationwide register data was used. Information on lifetime cannabis exposure was collected when participants were aged 15/16. Register-based outcome data on diagnoses made in clinical practice were obtained until age 33. Logistic regression was used to study the association of PLE/CE patterns and subsequent psychiatric disorders. The group with neither PLEs nor CE was utilized as the reference group. Parental psychiatric disorders, family structure, sex, frequent alcohol intoxications, daily smoking and illicit substance use other than cannabis were adjusted for.RESULTSIn all, 6552 subjects (49.2 % males) were included in analysis. PLEs with cannabis exposure were associated with any psychiatric disorder (OR = 2.59; 95 % CI 1.82-3.68), psychotic disorders (OR = 3.86; 95 % CI 1.83-8.11), mood disorders (OR 4.07; 95 % CI 2.74-6.04), depressive disorders (OR = 4.35; 95 % CI 2.93-6.48), anxiety disorders (OR = 2.06; 95 % CI 1.34-3.17) and substance use disorders (OR = 2.26; 95 % CI 1.13-4.50) compared to reference group. Effect sizes were greater for group with both PLEs and cannabis use than for group with PLEs only.CONCLUSIONSEarly-onset cannabis use is an adverse prognostic marker for adolescents with PLEs after extensive confounder control including other substance use.
  • A longitudinal qualitative follow-up study of post-traumatic growth among service users who experienced positive change following a first episode of psychosis

    Ng, Fiona (2022)
    Background: Posttraumatic growth refers to the positive psychological changes that people experience following a traumatic or adverse event; and has been reported among people who have experienced a first episode of psychosis. This body of research has an important limitation of not having examined how experiences of posttraumatic growth following a first episode of psychosis change over time. In this study, we examined different aspects and facilitators of posttraumatic growth approximately one year following participants’ initial interview. Methods: Data were collected via semi-structured individual interviews with seven participants and analyzed using thematic analysis. Themes generated from the follow-up interviews were compared with those developed from the initial interviews. Results: Participants experienced challenges at the intersection of trauma, social adversity, and oppression; yet they also reported an improved sense of self; improved relationships with others; embracing existing or new activities; and engaging with and giving back to others. These changes were facilitated by personal resources; social and community-based support; and traditional mental health services and interventions. Discussion: Posttraumatic growth may continue over time. The broader social determinants of health that may lead to a resurgence of psychosis and potential challenges to posttraumatic growth, such as inequality, poverty, and discrimination, should be addressed. © 2022 Informa UK Limited, trading as Taylor & Francis Group.
  • Cortical impoverishment in a stable subgroup of schizophrenia: Validation across various stages of psychosis

    Liddle, Peter F. (2022)
    BACKGROUNDCortical thinning is a well-known feature in schizophrenia. The considerable variation in the spatial distribution of thickness changes has been used to parse heterogeneity. A 'cortical impoverishment' subgroup with a generalized reduction in thickness has been reported. However, it is unclear if this subgroup is recoverable irrespective of illness stage, and if it relates to the glutamate hypothesis of schizophrenia.METHODSWe applied hierarchical cluster analysis to cortical thickness data from magnetic resonance imaging scans of three datasets in different stages of psychosis (n = 288; 160 patients; 128 healthy controls) and studied the cognitive and symptom profiles of the observed subgroups. In one of the samples, we also studied the subgroup differences in 7-Tesla magnetic resonance spectroscopy glutamate concentration in the dorsal anterior cingulate cortex.RESULTSOur consensus-based clustering procedure consistently produced 2 subgroups of participants. Patients accounted for 75%-100% of participants in one subgroup that was characterized by significantly lower cortical thickness. Both subgroups were equally symptomatic in clinically unstable stages, but cortical impoverishment indicated a higher symptom burden in a clinically stable sample and higher glutamate levels in the first-episode sample. There were no subgroup differences in cognitive and functional outcome profiles or antipsychotic exposure across all stages.CONCLUSIONSCortical thinning does not vary with functioning or cognitive impairment, but it is more prevalent among patients, especially those with glutamate excess in early stages and higher residual symptom burden at later stages, providing an important mechanistic clue to one of the several possible pathways to the illness.

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